Provider Demographics
NPI:1679134829
Name:DR. CYNTHIA C. BANDERET, DMD, PC
Entity Type:Organization
Organization Name:DR. CYNTHIA C. BANDERET, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDERET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-234-8411
Mailing Address - Street 1:2630 MASCOUTAH AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221
Mailing Address - Country:US
Mailing Address - Phone:618-234-8411
Mailing Address - Fax:
Practice Address - Street 1:2630 MASCOUTAH AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221
Practice Address - Country:US
Practice Address - Phone:618-234-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. CYNTHIA C. BANDERET, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental